Pelvic Inflammatory Disease Management (CDC 2021)

Algorithm Steps

1. ▶

   Start

   Suspected PID

   Lower abdominal/pelvic pain in sexually active patient

   1. ●

      Action

      Diagnostic Criteria

      Minimum criteria for empiric treatment

      • MINIMUM CRITERIA (any one):
      • - Cervical motion tenderness
      • - Uterine tenderness
      • - Adnexal tenderness
      • ADDITIONAL CRITERIA (support diagnosis):
      • - Temp >38.3°C (101°F)
      • - Mucopurulent cervical discharge
      • - WBC on wet prep
      • - Elevated ESR or CRP
      • - Lab evidence of GC or chlamydia
      1. ●

         Action

         Diagnostic Workup

         Rule out emergencies, obtain cultures

         • Pregnancy test (rule out ectopic)
         • NAAT for GC and chlamydia
         • Wet prep/vaginal microscopy
         • HIV testing
         • Consider: CBC, CRP, urinalysis
         • Pelvic ultrasound if TOA suspected
         1. ◆

            Decision

            Severity Assessment

            Inpatient vs outpatient management

            1. ●

               Action

               Inpatient Criteria

               Admit if any present

               • Surgical emergency not excluded (appendicitis, ectopic)
               • Pregnant
               • Unable to tolerate oral meds (N/V)
               • Severe illness, high fever, peritonitis
               • Tubo-ovarian abscess
               • Failed outpatient therapy
               1. ●

                  Action

                  Inpatient IV Treatment

                  Parenteral regimens

                  • REGIMEN A:
                  • Ceftriaxone 1g IV q24h + Doxycycline 100mg IV/PO q12h + Metronidazole 500mg IV/PO q12h
                  • REGIMEN B:
                  • Cefoxitin 2g IV q6h + Doxycycline 100mg IV/PO q12h
                  • Transition to oral after 24-48h improvement
                  1. ●

                     Action

                     Follow-Up

                     Essential for all patients

                     • 72-hour follow-up for clinical improvement
                     • Partner treatment (expedited partner therapy)
                     • STI counseling and education
                     • Retest for GC/chlamydia in 3 months
                     • Counsel on fertility implications
                     1. ✓

                        Outcome

                        Resolution

                        Complete antibiotic course, test of cure

            2. ●

               Action

               Outpatient Treatment

               CDC 2021 recommended regimen

               • Ceftriaxone 500mg IM x1 (1g if ≥150kg)
               • PLUS Doxycycline 100mg PO BID x 14 days
               • PLUS Metronidazole 500mg PO BID x 14 days
               • Alternative cephalosporin + probenecid options available
               • Follow-up in 72 hours essential
               1. ⚠

                  Warning

                  Partner Notification

                  All sex partners in past 60 days

                  • Evaluate and treat presumptively
                  • Expedited partner therapy if allowed
                  • Abstain from intercourse until treatment complete
         2. ◆

            Decision

            Tubo-Ovarian Abscess?

            Ultrasound or clinical suspicion

            1. ●

               Action

               TOA Management

               May require drainage

               • IV antibiotics initially
               • Consider interventional drainage if >6-8cm
               • Surgical management if ruptured
               • Follow with imaging for resolution
               • May require prolonged antibiotics